Provider Demographics
NPI:1952692436
Name:O'BRIEN, SEAN PATRICK (MSW)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:PATRICK
Last Name:O'BRIEN
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:718 E GRETA AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208-5246
Mailing Address - Country:US
Mailing Address - Phone:509-834-9635
Mailing Address - Fax:833-563-2551
Practice Address - Street 1:104 S FREYA ST STE 314B
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-6206
Practice Address - Country:US
Practice Address - Phone:505-255-3161
Practice Address - Fax:833-563-2551
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-02
Last Update Date:2024-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACGG01890741041S0200X
WALW605930121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1952692436Medicaid
WA1952692436Medicaid